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Nelson J, Mayer S, Neininger MP, Bertsche A, Lacher M, Gosemann JH. Complementary and alternative medicine (CAM) is frequently used by parents for the treatment of functional constipation in children. J Pediatr Gastroenterol Nutr 2024; 78:573-582. [PMID: 38284644 DOI: 10.1002/jpn3.12111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 10/07/2023] [Accepted: 10/29/2023] [Indexed: 01/30/2024]
Abstract
OBJECTIVES Complementary and alternative medicine (CAM) has gained increasing attention as a supportive treatment for chronic diseases such as epilepsy, migraine, autism, and cancer in children. This study aimed to determine the frequency, motivation, and outcomes of CAM in children with functional constipation. METHODS From January 2018 till September 2019, parents of patients (0-18 years) who were treated for functional constipation (ROME IV-criteria) at our colorectal center were asked to complete a questionnaire on the utilization of CAM. Demographic data and clinical assessments were documented and analyzed for patients with and without CAM treatment. RESULTS A total of 115 patients were included (mean age: 5.1 years; 49% males), of whom 29 (25%) used CAM as an alternative (4/29,14%) or in addition to conventional therapy (CT), including osteopathy (48%), homeopathy (45%), and natural/herbal remedies (17%). The main reason parents reported for the use of CAM was the urge to leave no treatment option unattempted (76%). Multivariate analysis also identified persistent constipation under CT (72%), adverse effects of CT (24%), and parental use of CAM themselves (83%) as independent variables associated with CAM use. Parents reported positive changes in stool frequency (38%) and fecal incontinence (21%) with CAM. The vast majority (93%) plan to use CAM in the future, and even non-CAM users showed high interest (60%). CONCLUSION One in four children with functional constipation receives CAM. Significant improvement in stool frequency and continence is missing in the majority. However, parental interest in CAM remains high. Physicians should be aware of CAM when counseling families for functional constipation in children.
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Affiliation(s)
- Jana Nelson
- Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany
| | - Steffi Mayer
- Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany
| | - Martina P Neininger
- Department of Clinical Pharmacy, Leipzig University and Drug Safety Center, Institute of Pharmacy, Medical Faculty, Leipzig University and University Hospital, Leipzig, Germany
| | - Astrid Bertsche
- Department of Pediatric Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Martin Lacher
- Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany
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Gupta B, Misra P, Karuppusamy A, Balamurugan D, Parewa M, Tomar M, Rai S, Vashishth H, Sadhukhan S, Singh NK, Koley M, Saha S. Individualized Homeopathic Medicines as Adjunctive Treatment of Pediatric Epilepsy: A Double-Blind, Randomized, Placebo-Controlled Trial. HOMEOPATHY 2023; 112:170-183. [PMID: 36513330 DOI: 10.1055/s-0042-1755361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Epilepsy, one of the most common neurological diseases, contributes to 0.5% of the total disease burden. The burden is highest in sub-Saharan Africa, central Asia, central and Andean Latin America, and south-east Asia. Asian countries report an overall prevalence of 6/1,000 and that in India of 5.59/1,000. We examined whether individualized homeopathic medicines (IHMs) can produce a significantly different effect from placebos in treatment of pediatric epilepsy in the context of ongoing standard care (SC) using anti-epileptic drugs (AEDs). METHODS The study was a 6-month, double-blind, randomized, placebo-controlled trial (n = 60) conducted at the pediatric outpatient department of a homeopathic hospital in West Bengal, India. Patients were randomized to receive either IHMs plus SC (n = 30) or identical-looking placebos plus SC (n = 30). The primary outcome measure was the Hague Seizure Severity Scale (HASS); secondary outcomes were the Quality of Life in Childhood Epilepsy (QOLCE-16) and the Pediatric Quality of Life inventory (PedsQL) questionnaires; all were measured at baseline and after the 3rd and 6th month of intervention. The intention-to-treat sample was analyzed to detect group differences and effect sizes. RESULTS Recruitment and retention rates were 65.2% and 91.7% respectively. Although improvements were greater in the IHMs group than with placebos, with small to medium effect sizes, the inter-group differences were statistically non-significant - for HASS (F 1, 58 = 0.000, p = 1.000, two-way repeated measures analysis of variance), QOLCE-16 (F 1, 58 = 1.428, p = 0.237), PedsQL (2-4 years) (F 1, 8 = 0.685, p = 0.432) and PedsQL (5-18 years) (F 1, 47 = 0.000, p = 0.995). Calcarea carbonica, Ignatia amara, Natrum muriaticum and Phosphorus were the most frequently prescribed medicines. No serious adverse events were reported from either of the two groups. CONCLUSION Improvements in the outcome measures were statistically non-significantly greater in the IHMs group than in the placebos group, with small effect sizes. A different trial design and prescribing approach might work better in future trials. TRIAL REGISTRATION CTRI/2018/10/016027.
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Affiliation(s)
- Bharti Gupta
- Department of Pediatrics, National Institute of Homoeopathy, Salt Lake, Kolkata, West Bengal, India
| | - Pankhuri Misra
- Department of Materia Medica, National Institute of Homoeopathy, Salt Lake, Kolkata, West Bengal, India
| | - Avaranjika Karuppusamy
- Department of Materia Medica, National Institute of Homoeopathy, Salt Lake, Kolkata, West Bengal, India
| | - Dharshna Balamurugan
- Department of Materia Medica, National Institute of Homoeopathy, Salt Lake, Kolkata, West Bengal, India
| | - Maneet Parewa
- Department of Repertory, National Institute of Homoeopathy, Salt Lake, Kolkata, West Bengal, India
| | - Maneela Tomar
- Department of Organon of Medicine and Homeopathic Philosophy, National Institute of Homoeopathy, Salt Lake, Kolkata, West Bengal, India
| | - Shruti Rai
- Department of Organon of Medicine and Homeopathic Philosophy, National Institute of Homoeopathy, Salt Lake, Kolkata, West Bengal, India
| | - Himani Vashishth
- Department of Repertory, National Institute of Homoeopathy, Salt Lake, Kolkata, West Bengal, India
| | - Satarupa Sadhukhan
- Department of Organon of Medicine and Homeopathic Philosophy, National Institute of Homoeopathy, Salt Lake, Kolkata, West Bengal, India
| | - Navin Kumar Singh
- Department of Repertory, The Calcutta Homoeopathic Medical College and Hospital, Kolkata, West Bengal; affiliated to The West Bengal University of Health Sciences, Govt. of West Bengal, West Bengal, India
| | - Munmun Koley
- Department of Homeopathy, East Bishnupur State Homoeopathic Dispensary, Chandi Daulatabad Block Primary Health Centre, West Bengal, under Department of Health & Family Welfare, Govt. of West Bengal, West Bengal, India
| | - Subhranil Saha
- Department of Repertory, D. N. De Homoeopathic Medical College and Hospital, Govt. of West Bengal, Kolkata, West Bengal, India
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İnce T, İnce G, Üzüm Ö, Aydın A. Parent-reported complementary and alternative medicine use among pediatric patients with epilepsy at two tertiary centers in Turkey - Prevalence and predictors. Epilepsy Behav 2023; 143:109226. [PMID: 37141770 DOI: 10.1016/j.yebeh.2023.109226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Complementary and alternative medicine (CAM) consists of various medical practices and products not recognized as a part of conventional medicine. There are few studies on CAMs used for childhood epilepsy. We aimed to determine the prevalence and socio-demographic factors affecting CAM use in children with epilepsy. METHODS This is a cross-sectional prospective descriptive study. The study included all parents who agreed to participate and had children with epilepsy. The data was collected using a questionnaire developed from a literature review of CAM use in pediatric epilepsy patients. RESULTS A total of 219 parent-child pairs were included in the study. Seventy-five participants had one or more comorbid disorders. 55.3% of participating children with epilepsy were taking more than one antiseizure medication (ASM). 30.1% of parents reported using some form of CAM for their children in the previous year. Only 60.6% of parents discussed their CAM decision with their child's doctor before using it. Univariate analysis showed that the patient's age, presence of comorbid disorders, duration of ASM, and family history of epilepsy were statistically significant predictors for CAM use. However, the presence of comorbidities was the only significant predictor of CAM use in logistic regression. CONCLUSION Even though most parents believe CAMs have no effect on their children with epilepsy, they frequently use them. We propose that the predictors identified in this study can help to identify potential CAM users. Since most parents do not report the use of CAM, physicians should routinely inquire about CAM use.
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Affiliation(s)
- Tolga İnce
- Dokuz Eylül University, Faculty of Medicine, Department of Pediatrics, Social Pediatrics Unit, İzmir, Turkey.
| | - Gülberat İnce
- University of Health Sciences, Tepecik Training and Research Hospital, Department of Pediatric Diseases, Izmir, Turkey.
| | - Özlem Üzüm
- University of Health Sciences, Tepecik Training and Research Hospital, Department of Pediatric Diseases, Izmir, Turkey
| | - Adem Aydın
- Dokuz Eylül University, Faculty of Medicine, Department of Pediatrics, Social Pediatrics Unit, İzmir, Turkey
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Zhu Z, Dluzynski D, Hammad N, Pugalenthi D, Walser SA, Mittal R, Samanta D, Brown ML, Asadi-Pooya AA, Kakooza-Mwesige A, Spalice A, Capponi M, Lekoubou A, Kumar A, Paudel S, Carney PR, Mainali G, Naik S. Use of Integrative, Complementary, and Alternative Medicine in Children with Epilepsy: A Global Scoping Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:713. [PMID: 37189961 PMCID: PMC10136598 DOI: 10.3390/children10040713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 03/23/2023] [Accepted: 04/06/2023] [Indexed: 05/17/2023]
Abstract
(1) Background: Epilepsy is one of the most common chronic neurological disorders in childhood. Complementary and alternative medicine (CAM) use is highly prevalent in patients with epilepsy. Despite CAM's widespread and increasing popularity, its prevalence, forms, perceived benefits, and potential risks in pediatric epilepsy are rarely explored. (2) Methods: We performed a scoping review of the available literature on the use of CAM in pediatric epilepsy. (3) Results: Overall, global cross-sectional studies showed a variable degree of CAM usage among children with epilepsy, ranging from 13 to 44% in prevalence. Popular types of CAMs reported were supplements, cannabis products, aromatherapy, herbal remedies, dietary therapy, massage therapy, and prayer. Families often report that CAM is effective, although there are limited objective measures of this. Potential risks lie in the use of CAM, such as herbal remedies, and/or unregulated, contaminated, or unpurified products. Studies also underscored inadequate patient-physician discussions regarding CAM. (4) Conclusions: A better understanding of this topic would aid clinicians in guiding patients/families on the use of CAM. Further studies on the efficacy of the different types of CAM used, as well as potential side effects and drug interactions are needed.
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Affiliation(s)
- Zahra Zhu
- College of Medicine, Penn State University, Hershey, PA 17033, USA (G.M.); (S.N.)
| | - Daniela Dluzynski
- College of Medicine, Penn State University, Hershey, PA 17033, USA (G.M.); (S.N.)
| | - Nouran Hammad
- School of Medicine, Jordan University of Science and Technology, Al-Ramtha 3030, Jordan
| | - Deepika Pugalenthi
- College of Medicine, Penn State University, Hershey, PA 17033, USA (G.M.); (S.N.)
| | - Sarah A. Walser
- Department of Psychiatry, Johns Hopkins Hospital, Baltimore, MD 21287, USA
| | - Rea Mittal
- College of Medicine, Penn State University, Hershey, PA 17033, USA (G.M.); (S.N.)
| | - Debopam Samanta
- Section of Child Neurology, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Melanie L. Brown
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - Ali A. Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz 71437, Iran
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Angelina Kakooza-Mwesige
- Department of Pediatrics & Child Health, Makerere University College of Health Sciences, Kampala 7062, Uganda
| | - Alberto Spalice
- Department of Maternal Sciences, University la Sapienza, 00185 Roma, Italy
| | - Martina Capponi
- Department of Maternal Sciences, University la Sapienza, 00185 Roma, Italy
| | - Alain Lekoubou
- College of Medicine, Penn State University, Hershey, PA 17033, USA (G.M.); (S.N.)
- Department of Neurology, Hershey Medical Center, Penn State University, Hershey, PA 17033, USA
- Department of Public Health Sciences, College of Medicine, Penn State University, Hershey, PA 17033, USA
| | - Ashutosh Kumar
- College of Medicine, Penn State University, Hershey, PA 17033, USA (G.M.); (S.N.)
- Department of Pediatrics and Neurology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Sita Paudel
- College of Medicine, Penn State University, Hershey, PA 17033, USA (G.M.); (S.N.)
- Department of Pediatrics and Neurology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Paul R. Carney
- Pediatric Neurology Division, University of Missouri Health Care, Columbia, MO 65212, USA
| | - Gayatra Mainali
- College of Medicine, Penn State University, Hershey, PA 17033, USA (G.M.); (S.N.)
- Department of Pediatrics and Neurology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Sunil Naik
- College of Medicine, Penn State University, Hershey, PA 17033, USA (G.M.); (S.N.)
- Department of Pediatrics and Neurology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA 17033, USA
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Arida RM. Physical Exercise as a Strategy to Reduce Seizure Susceptibility. PHARMACORESISTANCE IN EPILEPSY 2023:453-477. [DOI: 10.1007/978-3-031-36526-3_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Arida RM, Sales EPDN, Teixeira-Machado L, Prado GFD, Gutierre RC, Carrizosa J. Neurologists' knowledge of and attitudes toward physical exercise for people with epilepsy in Latin America. Epilepsy Behav 2022; 131:108705. [PMID: 35526463 DOI: 10.1016/j.yebeh.2022.108705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/30/2022] [Accepted: 04/07/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Despite the favorable effects of exercise in people with epilepsy (PWE), the lower participation in physical/sports activities may be partly due to inadequate knowledge and attitudes of health professional about their benefits. In this regard, in 2016, the International League Against Epilepsy (ILAE) through its Task Force on Sports and Epilepsy published a consensus paper that provided general guidance concerning participation in exercise/sport activities for PWE. We investigated views and attitudes toward physical exercise practice among neurologists in Latin America. METHODS A 22-item cross-sectional online questionnaire-based study among neurologists included the following: (1) profile of participating neurologists, (2) doctors' attitudes and perceptions about physical/sport activities for PWE, and (3) neurologist experience concerning patient's report about their involvement in physical/sport activities. RESULTS In total, 215 of 519 neurologists from 16 different countries returned the questionnaire. Although about one-third of neurologists had no information about the effect of exercise on epilepsy, and 60% of them did not know the published recommendations of the ILAE Task Force on Sports and Epilepsy, the majority (92.5%) advised the practice of exercise, were aware of sport activities for their patients and agreed that exercise can reduce comorbidities associated with epilepsy (X2 = 249.34; p < 0.001). Most of the neurologists did not believe that exercise is a seizure-inducing factor, but more than half would restrict their patients with uncontrolled seizures for exercise practice (X2 = 250.77; p < 0.001). Most barriers considered by PWE in the past, currently are not viewed by neurologists and their patients (X2 = 249.34; p < 0.001). CONCLUSION While this study reveals that neurologists have some knowledge gaps in attitudes toward physical exercise for PWE, encouraging attitudes were observed by neurologists. Considering that physicians can impact on patient confidence and decision, a better communication between neurologists and their patients concerning the benefits of exercise can increase PWE participation in physical/sports activities. To improve this scenario, more efforts should be made to increase the neurologists' knowledge and perceptions on this issue.
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Affiliation(s)
- Ricardo Mario Arida
- Department of Physiology, Federal University of São Paulo, São Paulo, Brazil.
| | | | | | | | | | - Jaime Carrizosa
- Pediatric Department Child Neurology Service, University of Antioquia, Medellín, Colombia
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Neininger MP, Jeschke S, Kiesel LM, Bertsche T, Bertsche A. Physicians' perspectives on adverse drug reactions in pediatric routine care: a survey. World J Pediatr 2022; 18:50-58. [PMID: 34773600 PMCID: PMC8761136 DOI: 10.1007/s12519-021-00478-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 10/26/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Children and adolescents are at particular risk for adverse drug reactions (ADRs). We investigated physicians' perceptions on ADRs in pediatric routine care. METHODS In this exploratory study from April to November 2020, we invited physicians treating pediatric patients across Germany to complete an online questionnaire consisting mainly of closed questions. RESULTS Completion rate was 98% (127/129). Of all participants, 23% (29/127) stated they were not able to estimate how many of their pediatric patients experienced ADRs during drug therapy. The remaining physicians estimated that 7.5% (median; Q25/Q75 3%/20%) of their pediatric patients were affected by ADRs. Regarding counseling on ADRs, 61% (77/127) stated they do not ask regularly the extent to which parents want to be informed. In total, 26% (33/127) stated they avoid counseling on ADRs concerning commonly used approved therapies, whereas only 4% (5/127) did so concerning off-label use (P < 0.001). Altogether, 16% (20/127) stated they rather prescribe new medicines as they hope for better effectiveness; 72% (91/127) said they are cautious about doing so owing to yet unknown ADRs. Of all respondents, 46% (58/127) stated they do not report ADRs to the authorities. Concerning the black triangle symbol, a European pharmacovigilance measure, 11% (14/127) stated they knew it and 6% (7/127) stated they reported any suspected ADR for drugs with that symbol. CONCLUSIONS Physicians' perspectives on ADRs were ambivalent: ADRs influenced their parent counseling and drug prescribing; yet, they struggled to estimate the impact of ADRs on their patients and were not aware of specific pharmacovigilance measures.
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Affiliation(s)
- Martina P. Neininger
- Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University and Drug Safety Center, Leipzig University and University Hospital, Bruederstrasse 32, 04103 Leipzig, Germany
| | - Sarah Jeschke
- University Hospital for Children and Adolescents, Neuropediatrics, Ernst-Heydemann-Str. 8, 18057 Rostock, Germany
| | - Lisa M. Kiesel
- Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University and Drug Safety Center, Leipzig University and University Hospital, Bruederstrasse 32, 04103 Leipzig, Germany
| | - Thilo Bertsche
- Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University and Drug Safety Center, Leipzig University and University Hospital, Bruederstrasse 32, 04103 Leipzig, Germany
| | - Astrid Bertsche
- University Hospital for Children and Adolescents, Neuropediatrics, Ernst-Heydemann-Str. 8, 18057 Rostock, Germany
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Xaviar S, Das S, Tiwari S. An Audit of the Quality of Reporting and Bias of Studies on Yoga in Epilepsy. Neurol India 2022; 70:2009-2014. [DOI: 10.4103/0028-3886.359244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Ho EY, Bylund CL, Wollney E, Peterson EB, Wong HN, Koenig CJ. A systematic review of communication about Complementary and Integrative Health (CIH) in global biomedical settings. PATIENT EDUCATION AND COUNSELING 2021; 104:2900-2911. [PMID: 34030929 DOI: 10.1016/j.pec.2021.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/08/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES A systematic review to analyze communication rates of complementary and integrative health (CIH) and analyze how communication terms, such as "disclosure," are measured and operationalized. METHODS We searched seven databases for studies published between 2010 and 2018 with quantitative measurements of patients' communication of CIH to a biomedical clinician. We analyzed communication terms used to describe patients reporting CIH usage. We also examined the conceptual and operational definitions of CIH provided and whether those terms were explicitly operationalized. We aggregated the percentage, rate, or ratio of CIH users that communicated about CIH with their clinicians by disease type and geographical region. RESULTS 7882 studies were screened and 89 included in the review. Studies used a wide range of conceptual and operational definitions for CIH, as well as 23 different terms to report communication related to reporting CIH usage. Usage varied by disease type and geographical region. CONCLUSIONS Studies of CIH and CIH communication may measure different kinds of social and communicative phenomena, which makes comparison across international studies challenging. PRACTICE IMPLICATIONS Future studies should employ standardized, replicable measures for defining CIH and for reporting CIH communication. Clinicians can incorporate questions about prior, current, and future CIH use during the medical visit.
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Affiliation(s)
- Evelyn Y Ho
- Department of Communication Studies, University of San Francisco, San Francisco, USA; Asian American Research Center on Health, San Francisco, USA.
| | - Carma L Bylund
- College of Journalism and Communications, University of Florida, Gainesville, USA
| | - Easton Wollney
- College of Journalism and Communications, University of Florida, Gainesville, USA
| | - Emily B Peterson
- Annenberg School for Communication and Journalism, University of Southern California, Los Angeles, USA
| | - Hong-Nei Wong
- Lane Medical Library & Knowledge Management Center, Stanford University School of Medicine, Stanford, Palo Alto, USA
| | - Christopher J Koenig
- Department of Communication Studies, San Francisco State University, San Francisco, USA; Medical Cultures Lab, University of California, San Francisco, San Francisco, USA
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A review of Korean medicine treatment on febrile convulsion and its possible treatment protocol about Korean medicine combined with conventional western medicine. ADVANCES IN TRADITIONAL MEDICINE 2021. [DOI: 10.1007/s13596-020-00500-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Asadi-Pooya AA, Brigo F, Lattanzi S, Karakis I, Asadollahi M, Trinka E, Talaat El Ghoneimy L, Pretorius C, Contreras G, Daza-Restrepo A, Valente K, D'Alessio L, Turuspekova ST, Aljandeel G, Khachatryan S, Ashkanani A, Tomson T, Kutlubaev M, Guekht A, Alsaadi T, Calle-Lopez Y, Mesraoua B, Ríos-Pohl L, Al-Asmi A, Villanueva V, Igwe SC, Kissani N, Jusupova A. Complementary and alternative medicine in epilepsy: A global survey of physicians' opinions. Epilepsy Behav 2021; 117:107835. [PMID: 33611098 DOI: 10.1016/j.yebeh.2021.107835] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/25/2020] [Accepted: 01/30/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE To investigate the opinions of physicians on the use of complementary and alternative medicine (CAM) in patients with epilepsy (PWE) worldwide. METHODS Online survey addressed to neurologists and psychiatrists from different countries. RESULTS Totally, 1112 physicians from 25 countries (different world region: Europe, North America, South America, Middle-East, Africa, Former Soviet Union Republics) participated; 804 (72.3%) believed that CAM might be helpful in PWE. The most commonly endorsed CAM included meditation (41%) and yoga (39%). Female sex, psychiatry specialization, and working in North and South America were associated with the belief that CAM is helpful in PWE. Two-hundred and forty five out of 1098 participants (22.3%) used/prescribed CAM to PWE; among them, 174 (71%) people perceived CAM to be less effective and 114 (46.5%) people found CAM to be safer than conventional antiseizure medications (ASMs). The most common reasons to prescribe CAM for PWE were: to satisfy the patient (49.9%), dissatisfaction with the efficacy (35.6%), and dissatisfaction with the adverse effects (31.2%) of conventional therapies. CONCLUSION Although the evidence supporting the use of CAM for the treatment of epilepsy is extremely sparse, most physicians worldwide believe that it could be integrated with the use of conventional ASMs, at least in some patients. High-quality controlled trials are warranted to provide robust evidence on the usefulness of CAM options in PWE.
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Affiliation(s)
- Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Francesco Brigo
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Ioannis Karakis
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Eugen Trinka
- Department of Neurology, Christian-Doppler Medical Centre, Paracelsus Medical University, 5020 Salzburg, Austria; Institute of Nursing Science and Practice, Paracelsus Medical University, 5020 Salzburg, Austria; Centre for Cognitive Neuroscience, 5020 Salzburg, Austria, Associated Member of the European Reference Network EpiCARE
| | | | - Chrisma Pretorius
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Guilca Contreras
- Department of Pediatric Neurology, Hospital Metropolitano, Quito, Ecuador
| | | | - Kette Valente
- Laboratory of Clinical Neurophysiology, Deparment of Psychiatry, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, Brazil
| | - Luciana D'Alessio
- Buenos Aires University, Epilepsy Center, Ramos Mejía and El Cruce Hospitals, IBCN-CONICET, Buenos Aires, Argentina
| | - Saule T Turuspekova
- Department of Nervous Diseases with a Course of Neurosurgery, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - Ghaieb Aljandeel
- Iraqi Council for Medical Specializations, Faculty of Epileptology, Medical City, Baghdad, Iraq
| | - Samson Khachatryan
- Department of Neurology and Neurosurgery, National Institute of Health, Yerevan, Armenia
| | | | - Torbjörn Tomson
- Department of Clinical Nueroscience, Karolinska institutet, Stockholm, Sweden
| | - Mansur Kutlubaev
- Department of Neurology, Bashkir State Medical University, Ufa, Russia
| | - Alla Guekht
- Moscow Research and Clinical Center for Neurospychiatry; Department of Neurology, Nerosurgery and Medical Genetics, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Taoufik Alsaadi
- Deptartment of Neurology, American Center for Psychiatry and Neurology, Dubai, United Arab Emirates
| | - Yamile Calle-Lopez
- Neurology Section, University of Antioquia, Fundación Clínica del Norte-Neuroclínica, Medellín, Colombia
| | - Boulenouar Mesraoua
- Neurosciences Department, Hamad Medical Corporation and Weill Cornell Medical College, Doha, Qatar
| | | | - Abdullah Al-Asmi
- Neurology Unit, Department of Medicine, College of Medicine and Health Sceinces, Sultan Qaboos University, Oman
| | - Vicente Villanueva
- Refractory Epilepsy Unit, Neurology Service, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Stanley C Igwe
- Department of NeuroPsychiatry, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
| | - Najib Kissani
- Laboratory of Clinical and Experimental Neuroscience, Faculty of Medicine, Cadi Ayyad University, Marrakech, Morocco; Department of Neurology, Teaching Hospital Mohammed VI, Marrakesh, Morocco
| | - Asel Jusupova
- Kyrgyz State Medical Academy, Neurology and Clinical Genetics Department, Bishkek, Kyrgyzstan
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Tastemel Ozturk T, Kanbur N, Ozmert EN, Gulhan B, Ozaltin F, Topaloglu R, Duzova A. Predictors for the use of herbal and dietary supplements in children and adolescents with kidney and urinary tract diseases. Eur J Pediatr 2021; 180:253-262. [PMID: 32761383 DOI: 10.1007/s00431-020-03757-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 07/21/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022]
Abstract
Complementary and alternative medicine are treatments administered alone or in combination with conventional medical treatments. Data on complementary and alternative medicine use in children with kidney and urinary tract diseases are limited. In this cross-sectional study, the frequency and preferred methods of complementary and alternative medicine use and factors associated with their use were evaluated in 201 patients (48% female; median age, 11 years; median disease duration, 5.1 years) with kidney and urinary tract diseases and 260 healthy (without chronic disease) controls. Data were collected through a questionnaire-based interview and patients' medical records. Herbal and dietary supplements, including fish oil, were the most commonly used complementary and alternative medicine agents in both groups. There was no difference in herbal and dietary supplement use between the groups when fish oil was excluded (29% vs. 28%; p = 0.88). Herbal and dietary supplements were mainly used to improve/mitigate renal disease (52%). Logistic regression analysis revealed that disease duration > 7 years (odds ratio (OR), 3.70; 95% confidence interval (CI), 1.48-9.20), current use of six or more drugs (OR, 5.6; 95% CI, 1.28-24.41), and recurrent urinary tract infection or nephrolithiasis (OR, 3.92; 95% CI, 1.02-15.09) were the independent risk factors for herbal and dietary supplement use, except fish oil. Middle socioeconomic status was associated with decreased herbal and dietary supplement use, except fish oil, compared with low socioeconomic status (OR, 0.30; 95% CI, 0.11-0.81). Herbal and dietary supplements were used by 78% patients, despite knowing that these products could have side effects; only 42% of the patients shared the information about herbal and dietary supplement use with their doctors.Conclusion: Herbal and dietary supplement use is frequent in children with kidney and urinary tract diseases. Educating health professionals regarding such use is mandatory for developing strategies to prevent critical consequences. What is Known: • Complementary and alternative medicine (CAM) practices are therapeutic approaches that do not have sufficient efficacy and safety evidence. • CAM is widely used in healthy children and in certain chronic diseases. What is New: • Herbal and dietary supplements (HDSs) were the most commonly used method in kidney and urinary tract diseases. • Duration of disease, number of drugs, and socioeconomic status are determinants of HDS use except fish oil.
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Affiliation(s)
- Tugba Tastemel Ozturk
- Division of Pediatric Nephrology, Hacettepe University Faculty of Medicine, Sihhiye, 06100, Ankara, Turkey
| | - Nuray Kanbur
- Division of Adolescent Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Elif Nursel Ozmert
- Division of Social & Developmental Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Bora Gulhan
- Division of Pediatric Nephrology, Hacettepe University Faculty of Medicine, Sihhiye, 06100, Ankara, Turkey
| | - Fatih Ozaltin
- Division of Pediatric Nephrology, Hacettepe University Faculty of Medicine, Sihhiye, 06100, Ankara, Turkey
| | - Rezan Topaloglu
- Division of Pediatric Nephrology, Hacettepe University Faculty of Medicine, Sihhiye, 06100, Ankara, Turkey
| | - Ali Duzova
- Division of Pediatric Nephrology, Hacettepe University Faculty of Medicine, Sihhiye, 06100, Ankara, Turkey.
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Elliott J, DeJean D, Potter BK, Coyle D, Clifford T, McCoy B, Wells GA. Barriers in accessing medical cannabis for children with drug-resistant epilepsy in Canada: A qualitative study. Epilepsy Behav 2020; 111:107120. [PMID: 32570201 DOI: 10.1016/j.yebeh.2020.107120] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 04/11/2020] [Accepted: 04/11/2020] [Indexed: 12/26/2022]
Abstract
INTRODUCTION The use of medical cannabis to treat drug-resistant epilepsy in children is increasing; however, there has been limited study of the experiences of parents with the current system of accessing medical cannabis for their children. METHODS In this qualitative study, we used a patient-centered access to care framework to explore the barriers faced by parents of children with drug-resistant epilepsy when trying to access medical cannabis in Canada. We conducted semistructured interviews with 19 parents to elicit their experiences with medical cannabis. We analyzed the data according to five dimensions of access, namely approachability, acceptability, availability, affordability, and appropriateness. RESULTS Parents sought medical cannabis as a treatment because of a perceived unmet need stemming from the failure of antiepileptic drugs to control their children's seizures. Medical cannabis was viewed as an acceptable treatment, especially compared with adding additional antiepileptic drugs. After learning about medical cannabis from the media, friends and family, or other parents, participants sought authorization for medical use. However, most encountered resistance from their child's neurologist to discuss and/or authorize medical cannabis, and many parents experienced difficulty in obtaining authorization from a member of the child's existing care team, leading them to seek authorization from a cannabis clinic. Participants described spending up to $2000 per month on medical cannabis, and most were frustrated that it was not eligible for reimbursement through public or private insurance programs. CONCLUSIONS Parents pursue medical cannabis as a treatment for their children's drug-resistant epilepsy because of a perceived unmet need. However, parents encounter barriers in accessing medical cannabis in Canada, and strategies are needed to ensure that children using medical cannabis receive proper care from healthcare professionals with training in epilepsy care, antiepileptic drugs, and medical cannabis.
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Affiliation(s)
- Jesse Elliott
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada; Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Canada.
| | | | - Beth K Potter
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Doug Coyle
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Tammy Clifford
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Bláthnaid McCoy
- Department of Paediatrics, University of Toronto, Ontario, Canada; Division of Neurology, The Hospital for Sick Children Toronto, Toronto, Ontario, Canada
| | - George A Wells
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada; Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Canada
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Arida RM. Physical exercise and seizure activity. Biochim Biophys Acta Mol Basis Dis 2020; 1867:165979. [PMID: 32980461 DOI: 10.1016/j.bbadis.2020.165979] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 09/05/2020] [Accepted: 09/17/2020] [Indexed: 02/06/2023]
Abstract
Neuroprotective and antiepileptogenic therapies have been extensively investigated for epilepsy prevention and treatment. This review gives an overview of the promising contribution of the ketogenic diet, a complementary treatment, on the intestinal microbiota to reduce seizure susceptibility. Next, the relevance of physical exercise is extensively addressed as a complementary therapy to reduce seizure susceptibility, and thereby impact beneficially on the epilepsy condition. In this context, particular attention is given to the potential risks and benefits of physical exercise, possible precipitant factors related to exercise and proposed mechanisms by which exercise can reduce seizures, and its antiepileptogenic effects. Finally, this review points to emerging evidence of exercise reducing comorbidities from epilepsy and improving the quality of life of people with epilepsy. Based on evidence from current literature, physical or sport activities represent a potential non-pharmacological intervention that can be integrated with conventional therapy for epilepsy.
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Affiliation(s)
- Ricardo Mario Arida
- Department of Physiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
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Woltermann S, Jeschke S, Herziger B, Müller RM, Kiess W, Bertsche T, Bertsche A, Neininger MP. Anticonvulsant long-term and rescue medication: The children's perspective. Eur J Paediatr Neurol 2020; 28:180-185. [PMID: 32727667 DOI: 10.1016/j.ejpn.2020.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 04/17/2020] [Accepted: 06/21/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Little is known about children's perspectives and attitudes towards their long-term and rescue anticonvulsant medication. METHODS We interviewed paediatric patients aged 6-18 years in two university hospitals concerning their anticonvulsant treatment based on a structured questionnaire. We also asked them to draw a picture titled "Me and my medication". RESULTS We interviewed 100 patients with anticonvulsant long-term medication. 87/100 patients considered their medication to be helpful. 66/100 patients gave an explanation on why a regular medication intake is important, e.g. "Reduction/prevention of seizures", "Otherwise I have to go to hospital", "I don't want to die" or "Kill the virus which is causing epilepsy". Of 92 patients with a prescribed rescue medication, 22 (24%) did not know about it. Of the remaining 70, 39 (56%) stated they always carry it with them. When asked to imagine being the physician and to inform about the medication, the children would use illustrative (e.g. brochures) or demonstration material (e.g. "real tablets") to aid their consultation (47/100). 55/100 would stress the necessity of a regular intake. 52 participants drew a picture related to the given topic. Of those, only 1 depicted rescue medication. CONCLUSION Paediatric patients mostly have a positive attitude towards their medication. However, misconceptions exist and participants expressed the desire for more interactive support in the medical counselling. Children are not sufficiently aware of their rescue medication in everyday life. Consequently, physicians should consider the children's needs in their consultations and put more focus on potentially life-saving rescue medication.
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Affiliation(s)
- Sarah Woltermann
- University Hospital for Children and Adolescents, Centre for Pediatric Research, Liebigstrasse 20a, 04103 Leipzig, Germany; Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University and Drug Safety Center, Leipzig University and University Hospital, Bruederstrasse 32, 04103 Leipzig, Germany.
| | - Sarah Jeschke
- University Hospital for Children and Adolescents, Neuropediatrics, Ernst-Heydemann-Strasse 8, 18057 Rostock, Germany.
| | - Birthe Herziger
- University Hospital for Children and Adolescents, Neuropediatrics, Ernst-Heydemann-Strasse 8, 18057 Rostock, Germany.
| | - Ruth Melinda Müller
- University Hospital for Children and Adolescents, Neuropediatrics, Ernst-Heydemann-Strasse 8, 18057 Rostock, Germany.
| | - Wieland Kiess
- University Hospital for Children and Adolescents, Centre for Pediatric Research, Liebigstrasse 20a, 04103 Leipzig, Germany.
| | - Thilo Bertsche
- Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University and Drug Safety Center, Leipzig University and University Hospital, Bruederstrasse 32, 04103 Leipzig, Germany.
| | - Astrid Bertsche
- University Hospital for Children and Adolescents, Centre for Pediatric Research, Liebigstrasse 20a, 04103 Leipzig, Germany; University Hospital for Children and Adolescents, Neuropediatrics, Ernst-Heydemann-Strasse 8, 18057 Rostock, Germany.
| | - Martina Patrizia Neininger
- Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University and Drug Safety Center, Leipzig University and University Hospital, Bruederstrasse 32, 04103 Leipzig, Germany.
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Elliott J, McCoy B, Clifford T, Potter BK, Wells GA, Coyle D. Economic Evaluation of Cannabinoid Oil for Dravet Syndrome: A Cost-Utility Analysis. PHARMACOECONOMICS 2020; 38:971-980. [PMID: 32406036 DOI: 10.1007/s40273-020-00923-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Cannabinoid oils are being increasingly used to treat Dravet syndrome, yet the long-term costs and outcomes of this approach are unknown. Thus, we examined the cost effectiveness of cannabinoid oil as an adjunctive treatment (added to clobazam and valproate), compared with adjunctive stiripentol or with clobazam and valproate alone, for the treatment of Dravet syndrome in children. METHODS We performed a probabilistic cost-utility analysis from the perspective of the Canadian public health care system, comparing cannabinoid oil and stiripentol (both on a background of clobazam and valproate) with clobazam and valproate alone. Costs and quality-adjusted life-years (QALYs) were estimated using a Markov model that followed a cohort of children aged from 5 to 18 years through model states related to seizure frequency. Model inputs were obtained from the literature. The cost effectiveness of adjunctive cannabinoid oil, adjunctive stiripentol, and clobazam/valproate alone was assessed through sequential analysis. The influence of perspective and other assumptions were explored in scenario analyses. All costs are expressed in 2019 Canadian dollars, and costs and QALYs were discounted at a rate of 1.5% per year. RESULTS The incremental cost per QALY gained with the use of adjunctive cannabinoid oil, from the health care system perspective, was $32,399 compared with clobazam and valproate. Stiripentol was dominated by cannabinoid oil, producing fewer QALYs at higher costs. At a willingness-to-pay threshold of $50,000, cannabinoid oil was the optimal treatment in 76% of replications. From a societal perspective, cannabinoid oil dominated stiripentol and clobazam/valproate. The interpretation of the results was insensitive to model and input assumptions. CONCLUSION Compared with clobazam/valproate, adjunctive cannabinoid oil may be a cost-effective treatment for Dravet syndrome, if a decision maker is willing to pay at least $32,399 for each QALY gained. The opportunity costs of continuing to fund stiripentol, but not cannabinoid oil, should be considered.
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Affiliation(s)
- Jesse Elliott
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, Canada.
| | - Bláthnaid McCoy
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
- Division of Neurology, The Hospital for Sick Children Toronto, Toronto, ON, Canada
| | - Tammy Clifford
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Beth K Potter
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - George A Wells
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, Canada
| | - Doug Coyle
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
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Oflu A, Bukulmez A, Gorel O, Acar B, Can Y, Ilgaz NC, Yenioglu I, Uygun S, Sulecik S. Complementary and alternative medicine experiences of mothers in the treatment of infantile colic. Sudan J Paediatr 2020; 20:49-57. [PMID: 32528201 DOI: 10.24911/sjp.106-1568897690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Lack of effective medical treatment in infantile colic (IC) causes desperate mothers to apply for complementary and alternative medicine (CAM) treatments. Due to the possibility of benefits, the risks that may be incurred by these methods are often ignored by the parents. Therefore, information on the use of CAM methods in IC is needed. The aim of this study is to reveal the CAM experiences of mothers in IC treatment and the demographic characteristics that affect them. Mothers whose children were diagnosed as IC by a physician in the past were included in the study. The sociodemographic characteristics of the mothers, IC-diagnosed baby characteristics and CAM experiences were investigated face to face with a structured questionnaire. Sixty-six of 96 mothers who participated in the study used the CAM method. There was a statistically significant difference between the use of CAM and the education level of mothers (p < 0.05). We determined that 74% of mothers informed their doctors before starting treatments, and 82% do not believe if the CAM method could cause any harm that they would not notice by observing. The results showed that CAM methods are commonly used in IC treatment. According to these findings, mothers who use these methods believe that they are always harmless and have no side effects. For this reason, physicians should be careful about the adverse effects that may occur due to the CAM methods, which are widely used.
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Affiliation(s)
- Ayse Oflu
- Department of Pediatrics, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Aysegul Bukulmez
- Department of Pediatrics, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Oya Gorel
- Sixth Semester Medical Student, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Busegul Acar
- Sixth Semester Medical Student, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Yusuf Can
- Sixth Semester Medical Student, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Nihat Cem Ilgaz
- Sixth Semester Medical Student, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Ibrahim Yenioglu
- Sixth Semester Medical Student, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Serkan Uygun
- Sixth Semester Medical Student, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Sultan Sulecik
- Sixth Semester Medical Student, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
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18
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Neininger MP, Woltermann S, Jeschke S, Herziger B, Müller RM, Kiess W, Bertsche T, Bertsche A. How do pediatric patients perceive adverse drug events of anticonvulsant drugs? A survey. Eur J Pediatr 2020; 179:1413-1420. [PMID: 32162065 PMCID: PMC7413904 DOI: 10.1007/s00431-020-03571-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/20/2019] [Accepted: 01/08/2020] [Indexed: 11/27/2022]
Abstract
Anticonvulsant drugs have a high risk of adverse drug events. Little is known about the perception of those events by pediatric patients. We performed a survey in the neuropediatric departments of two university hospitals. Using a questionnaire, we interviewed patients aged 6-18 years with current anticonvulsant treatment regarding (i) their fears about potential adverse drug events, (ii) experienced adverse drug events, and (iii) perceived burden of experienced adverse drug events. One hundred patients took part in the interview. (i) 40 (40%) expressed fears that the medication could harm them. Eighteen of 40 (45%) named fears concerning specific adverse drug events. Of those, 12/18 (67%) feared neurologic or psychiatric symptoms. (ii) 37 (37%) of children described altogether 60 experienced adverse drug events. Of those, 38 (63%) concerned neurologic or psychiatric symptoms. (iii) 32/37 (82%) children who experienced adverse drug events felt bothered by the experienced event. Among others, they described an emotional burden (11/37, 30%), and restrictions in school performance (8/37, 22%) and favorite leisure activities (4/37, 11%).Conclusion: School-aged children are well able to describe adverse drug events of their anticonvulsant medication. Almost two thirds of the described events concern neurologic or psychiatric symptoms that cause an emotional burden and restrictions according to the patients. What is Known: • Anticonvulsants have a high potential of adverse drug events. • In an earlier survey, parents expressed fears of severe adverse drug events such as liver failure, which seldom occur, and reported a high number of neurological and psychological adverse drug events. What is New: • Many children fear that their anticonvulsants could harm them, and they fear and experience neurological and psychological adverse drug events. • According to the children, adverse drug events cause an emotional burden and restrictions in school performance and favorite leisure activities.
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Affiliation(s)
- Martina Patrizia Neininger
- Drug Safety Center and Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University, Brüderstraße 32, 04103 Leipzig, Germany
| | - Sarah Woltermann
- Drug Safety Center and Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University, Brüderstraße 32, 04103 Leipzig, Germany
- Center for Pediatric Research, University Hospital for Children and Adolescents, Liebigstraße 20a, 04103 Leipzig, Germany
| | - Sarah Jeschke
- Neuropaediatrics, University Hospital for Children and Adolescents, Ernst-Heydemann-Str. 8, 18057 Rostock, Germany
| | - Birthe Herziger
- Neuropaediatrics, University Hospital for Children and Adolescents, Ernst-Heydemann-Str. 8, 18057 Rostock, Germany
| | - Ruth Melinda Müller
- Neuropaediatrics, University Hospital for Children and Adolescents, Ernst-Heydemann-Str. 8, 18057 Rostock, Germany
| | - Wieland Kiess
- Center for Pediatric Research, University Hospital for Children and Adolescents, Liebigstraße 20a, 04103 Leipzig, Germany
| | - Thilo Bertsche
- Drug Safety Center and Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University, Brüderstraße 32, 04103 Leipzig, Germany
| | - Astrid Bertsche
- Center for Pediatric Research, University Hospital for Children and Adolescents, Liebigstraße 20a, 04103 Leipzig, Germany
- Neuropaediatrics, University Hospital for Children and Adolescents, Ernst-Heydemann-Str. 8, 18057 Rostock, Germany
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Asadi-Pooya AA, Homayoun M, Sharifi S. Complementary and integrative medicine in epilepsy: What patients and physicians perceive. Epilepsy Behav 2019; 101:106545. [PMID: 31704582 DOI: 10.1016/j.yebeh.2019.106545] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/27/2019] [Accepted: 09/03/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE The purpose of the current study was to investigate the extent to which people with epilepsy (PWE) use complementary and integrative medicine (CIM) to treat their illness and to assess their perceptions. We also investigated the perceptions of their treating physicians. METHODS In this cross-sectional study, all adult patients with epilepsy, who had the illness for at least one year, were recruited at the outpatient epilepsy clinic at Shiraz University of Medical Sciences, from January 2019 until March 2019. A questionnaire was designed for this survey. We also designed a similar questionnaire to investigate perceptions of the physicians in the same region. RESULTS One hundred and one patients participated. Seventy-one patients (70%) believed that CIM would be helpful in treating seizures; the most commonly reported CIM therapies were prayers, exercise, and herbs. Sixteen patients (16%) had actually used CIM to treat their seizures, but only one patient perceived that CIM was more effective than antiepileptic drugs to bring her seizures under control. Thirty-one neurologists participated in the study. Seventeen neurologists (55%) believed that CIM would be helpful in treating epileptic seizures. The most commonly reported CIM therapies were meditation, yoga, and exercise. CONCLUSION Complementary and integrative medicine is considered and used by many PWE to treat epileptic seizures. Cultural issues probably play an important role in having faith in CIM. Physicians involved in the care of PWE should provide appropriate information regarding the safety and efficacy of various CIM treatments for PWE.
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Affiliation(s)
- Ali A Asadi-Pooya
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Maryam Homayoun
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Samira Sharifi
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Elliott J, van Katwyk S, McCoy B, Clifford T, Potter BK, Skidmore B, Wells GA, Coyle D. Decision Models for Assessing the Cost Effectiveness of Treatments for Pediatric Drug-Resistant Epilepsy: A Systematic Review of Economic Evaluations. PHARMACOECONOMICS 2019; 37:1261-1276. [PMID: 31201643 DOI: 10.1007/s40273-019-00816-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Drug-resistant epilepsy affects about one-third of children with epilepsy and is associated with high costs to the healthcare system, yet the cost effectiveness of most treatments is unclear. Use of cannabis-based products for epilepsy is increasing, and the cost effectiveness of such strategies relative to conventional pharmacologic treatments must be considered. OBJECTIVE The objective of this systematic review was to identify economic evaluations of cannabis-based treatments for pediatric drug-resistant epilepsy. We also sought to identify and appraise decision models that have been used in economic evaluations of pharmacologic treatments (i.e., antiepileptic drugs) in this population. METHODS Electronic searches of MEDLINE, EMBASE, and the Cochrane library, as well as a targeted grey literature search, were undertaken (11 June 2018). Model-based full economic evaluations involving cannabis-based treatments or pharmacologic treatments for drug-resistant epilepsy in children were eligible for inclusion. Two independent reviewers selected studies for inclusion, and study quality was assessed by use of the Drummond and Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklists. Study findings, as well as model characteristics, are narratively summarized. RESULTS Nine economic evaluations involving children with drug-resistant epilepsy were identified; however, none involved cannabis-based treatments. All studies involved pharmacologic treatments compared with other pharmacologic treatments or non-pharmacologic treatments (i.e., ketogenic diet, epilepsy surgery, vagus nerve stimulation). Few studies have assessed the cost effectiveness of pharmacologic treatments in specific drug-resistant epilepsy syndromes, including Dravet and Lennox-Gastaut syndromes. Five included studies involved use of Markov models with a similar structure (i.e., health states based on seizure frequency relative to baseline). There was a wide range of methodological quality, and few studies fully addressed context-specific issues such as weight gain and treatment switching. CONCLUSION Whether cannabis-based treatments for pediatric drug-resistant epilepsy represent good value for money has yet to be investigated. Economic evaluations of such treatments are needed and should address issues of particular importance in pediatric epilepsy, including weight gain over time, switching or discontinuation of treatments, effectiveness of interventions and comparators, and long-term effectiveness beyond the duration of available clinical studies. PROSPERO REGISTRATION CRD42018099591.
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Affiliation(s)
- Jesse Elliott
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
| | - Sasha van Katwyk
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Bláthnaid McCoy
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
- Division of Neurology, The Hospital for Sick Children Toronto, Toronto, ON, Canada
| | - Tammy Clifford
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Beth K Potter
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | | | - George A Wells
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, Canada
| | - Doug Coyle
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
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Bosak M, Słowik A. Use of complementary and alternative medicine among adults with epilepsy in a university epilepsy clinic in Poland. Epilepsy Behav 2019; 98:40-44. [PMID: 31299531 DOI: 10.1016/j.yebeh.2019.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 06/02/2019] [Accepted: 06/02/2019] [Indexed: 12/28/2022]
Abstract
INTRODUCTION The use of complementary and alternative medicine (CAM) is becoming increasingly prevalent both in general population and patients with chronic diseases. The aim of the study was to determine the prevalence, reasons, and factors influencing the use of CAM in Polish patients with epilepsy (PWE). MATERIAL AND METHODS This prospective study involved PWE treated in a university epilepsy clinic. Data on epilepsy, antiepileptic drugs, level of education, vocational activity, and patterns of CAM were collected from a structured interview and from medical records. RESULTS The sample population consisted of 473 PWE (mean age: 35.3 years); 220 (46.5%) were females, and 228 (46.5%) were in remission. Overall 26.8% (127) of the cohort used at least one type of CAM. The CAM modalities most frequently used were herbal and dietary supplements (32.3%), energy healing (31.5%), and marijuana (27.6%). The internet was the most common source of information on CAM (45.7%). In one-third of subjects, CAM usage affected negatively compliance to standard treatment. Logistic regression analysis revealed several independent risk factors for CAM use in PWE: younger age, longer duration of epilepsy, lack of remission, and lower level of education. CONCLUSION A significant proportion of PWE uses CAM, and its usage may affect negatively compliance to standard treatment. Our findings highlight poor communication between patients and physicians with regard to CAM use. Healthcare professionalists should routinely check for CAM utilization in PWE to prevent potential harm related to its use.
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Affiliation(s)
- Magdalena Bosak
- Dept. of Neurology, Jagiellonian University Medical College, Krakow, Poland.
| | - Agnieszka Słowik
- Dept. of Neurology, Jagiellonian University Medical College, Krakow, Poland
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Elliott J, McCoy B, Clifford T, Potter BK, Skidmore B, Wells GA, Coyle D. Cost-effectiveness of cannabinoids for pediatric drug-resistant epilepsy: protocol for a systematic review of economic evaluations. Syst Rev 2019; 8:75. [PMID: 30917869 PMCID: PMC6436234 DOI: 10.1186/s13643-019-0990-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 03/15/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Drug-resistant epilepsy negatively impacts the quality of life and is associated with increased morbidity and mortality and high costs to the healthcare system. Cannabis-based treatments may be effective in reducing seizures in this population, but whether they are cost-effective is unclear. In this systematic review, we will search for cost-effectiveness analyses involving the treatment of pediatric drug-resistant epilepsy with cannabis-based products to inform decision-making by public healthcare payers about reimbursement of such products. We will also search for cost-effectiveness analyses of other pharmacologic treatments for pediatric drug-resistant epilepsy, as well as estimates of healthcare resource use, costs, and utilities, for use in a subsequent cost-utility analysis to address this decision problem. METHODS We will search the published and gray literature for economic evaluations of cannabis-based products and other pharmacologic treatments for pediatric drug-resistant epilepsy, as well as resource utilization and utility studies. Two independent reviewers will screen the title and abstract of each identified record and the full-text version of any study deemed potentially relevant. Study and population characteristics, the incremental cost-effectiveness ratio (ICER), as well as total costs and benefits, will be extracted, and quality will be assessed by use of the Drummond and CHEERS checklists; context-specific issues will also be considered. From model-based cost-utility and cost-effectiveness analyses, we will extract and summarize the model structure, including health states, time horizon, and cycle length. From resource utilization studies, we will extract data about the frequency of resource use (e.g., neurology visits, emergency department visits, admissions to hospital). From utility studies, we will extract the utility for each health state, the source of the preferences (e.g., child, parent, patient, general public), and the method of elicitation. DISCUSSION Drug-resistant epilepsy in children is associated with important costs to the healthcare system, and decision-makers require high-quality evidence on which to base reimbursement decisions. The results of this review will be useful to both decision-makers considering the decision problem of whether to reimburse cannabis-based products through public formularies and to analysts conducting studies in this area. SYSTEMATIC REVIEW REGISTRATION PROSPERO no.: CRD42018099591 .
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Affiliation(s)
- Jesse Elliott
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, K1G 5Z3 Canada
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, K1Y4W7 Canada
| | - Bláthnaid McCoy
- Department of Paediatrics, University of Toronto, Division of Neurology, The Hospital for Sick Children Toronto, Toronto, Ontario Canada
| | - Tammy Clifford
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, K1G 5Z3 Canada
| | - Beth K. Potter
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, K1G 5Z3 Canada
| | | | - George A. Wells
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, K1G 5Z3 Canada
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, K1Y4W7 Canada
| | - Doug Coyle
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, K1G 5Z3 Canada
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Lee B, Kwon CY, Chang GT. Oriental Herbal Medicine for Neurological Disorders in Children: An Overview of Systematic Reviews. THE AMERICAN JOURNAL OF CHINESE MEDICINE 2019; 46:1701-1726. [DOI: 10.1142/s0192415x18500866] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Oriental herbal medicine (OHM) has been widely used in pediatric neurological disorders and has attracted attention as a safe and effective treatment. We aim to summarize and evaluate the evidence for OHM in pediatric neurological disorders for evidence-based decision-making. Without language restrictions, up-to-date research data were obtained from nine electronic databases. Systematic reviews (SRs) assessing the efficacy of OHM for pediatric neurological disorders were included. The methodological quality of each review was assessed using the AMSTAR instrument. The quality of evidence for the main findings was evaluated using the GRADE approach. Sixteen SRs comprising 169 randomized controlled trials with 19,542 participants were included. In epilepsy (six SRs, [Formula: see text]), OHM as an adjunctive or alternative therapy to antiepileptic drugs showed higher clinical symptom improvements than did antiepileptic drugs alone. The Activities of Daily Living scale score was significantly higher in children with cerebral palsy (one SR, [Formula: see text]) when OHM was added to rehabilitation. There were inconsistent results for tic disorder (four SRs, [Formula: see text]) and enuresis (two SRs, [Formula: see text]) and unclear results for attention deficit hyperactivity disorder (two SRs, [Formula: see text]) and autism spectrum disorder (one SR, [Formula: see text]). Eleven SRs reported adverse events, but no fatal adverse reaction was reported. The methodological quality of the included reviews was medium-to-high. The overall quality of evidence ranged from “very low” to “moderate.” In conclusion, the efficacy of OHM is promising for some pediatric neurological disorders such as epilepsy and cerebral palsy. However, more high-quality evidence is needed to make clinical recommendations on OHM use.
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Affiliation(s)
- Boram Lee
- Department of Pediatrics of Korean Medicine, Kyung Hee University, Korean Medicine Hospital at Gangdong, Seoul 05278, Republic of Korea
| | - Chan-Young Kwon
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Gyu Tae Chang
- Department of Pediatrics of Korean Medicine, Kyung Hee University, Korean Medicine Hospital at Gangdong, Seoul 05278, Republic of Korea
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul 02447, Republic of Korea
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Achstetter K, Teut M. Use of Self-Medication with Homeopathy in Germany: Results of an Online Questionnaire Survey. Complement Med Res 2018; 25:383-390. [PMID: 30286479 DOI: 10.1159/000485077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Little is known about self-medication with homeopathic drugs in Germany. The aim of this study was to gain information about users, sources of information and the selection process of the drugs. METHODS An online questionnaire survey among users of self-medication with homeopathy was conducted via social media and email newsletters. RESULTS A total of 665 users who responded to the questionnaire were included. Most of the respondents were women (92%) in their mid-forties with high educational status. In total, 43% of the participants reported a household member working in the health sector. Books (65%) and Internet (47%) were the most common sources of information. Consultations in pharmacies - with a mean duration of 10 min - were likely to be used (60%). Homeopathic drugs were mainly used in the potency D12 (55%), for a duration of 5 days, 3 times daily, with 5 globules. Homeopathic drugs were mainly used due to good therapeutic experiences in the past (82%). Indications for use were acute diseases (91%), particularly colds (86%), as well as chronic diseases (51%) and prevention (47%). The selection of a homeopathic drug took the participants 25 min on average. CONCLUSION Homeopathic self-medication is understood by users as a resource to regain, maintain, and promote health. Further research about the quality and applicability of information for homeopathic self-medication is necessary.
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Fisch SM, Neininger MP, Prenzel F, Bernhard MK, Hornemann F, Merkenschlager A, Kiess W, Bertsche T, Bertsche A. Experiences, expectations, and fears of adolescents with epilepsy or bronchial asthma. Eur J Pediatr 2018; 177:1451-1457. [PMID: 29967923 DOI: 10.1007/s00431-018-3200-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 06/19/2018] [Accepted: 06/20/2018] [Indexed: 12/19/2022]
Abstract
UNLABELLED Epilepsy and bronchial asthma are frequent in adolescents. Data on adolescents' experiences with their disease and on their expectations for the future, however, is scarce. Patients of a university hospital aged 12 to 17 with epilepsy or bronchial asthma were interviewed based on a questionnaire. Forty-five patients with epilepsy and 47 with bronchial asthma were interviewed. Adolescents with epilepsy felt more impaired by their disease (median 2.5; Q25/Q75 0.75/3.0; 6-level Likert scales: 0 = not at all, 5 = very strong) than those with asthma (1.0; 0/3.0; p = 0.017). Seventy-nine patients (85.9%) had never used the Internet to gain information about their disease. Adolescents with epilepsy felt more limited in their career possibilities by their disease (2.0; 0/4.0) than those with asthma (0; 0/2.0; p = 0.001) and had a higher level of concern about passing their disease on to their children (3.0; 0/4.0) than their peers with asthma (1.5; 1.5/3.0; p = 0.016). Girls with epilepsy were more anxious (4.0; 0.5/5.0) than girls with asthma (0; 0/4.0) about complications of the disease regarding pregnancy (p = 0.019). CONCLUSION As well adolescents with epilepsy as with asthma described limitations of their daily life and concerns about the future. What is Known: • Epilepsy and bronchial asthma are frequent chronic diseases in adolescents. • Those diseases can affect psychosocial development. What is New: • Adolescents with epilepsy and bronchial asthma described a high burden of their disease, and most adolescents had not used the Internet to inform themselves on their disease. • Especially adolescents with epilepsy fear limitations in their job possibilities, inheritance of their disease and complications in their prospective pregnancy.
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Affiliation(s)
- Susanne Marie Fisch
- University Hospital for Children and Adolescents, Centre of Pediatric Research, Liebigstraße 20a, 04103, Leipzig, Germany
| | - Martina Patrizia Neininger
- Drug Safety Center and Dept. of Clinical Pharmacy, Leipzig University, Brüderstraße 32, 04103, Leipzig, Germany
| | - Freerk Prenzel
- University Hospital for Children and Adolescents, Centre of Pediatric Research, Liebigstraße 20a, 04103, Leipzig, Germany.,Leipzig Interdisciplinary Center for Allergy (LICA), University Hospital, Liebigstraße 20a, 04103, Leipzig, Germany
| | - Matthias Karl Bernhard
- University Hospital for Children and Adolescents, Centre of Pediatric Research, Liebigstraße 20a, 04103, Leipzig, Germany
| | - Frauke Hornemann
- University Hospital for Children and Adolescents, Centre of Pediatric Research, Liebigstraße 20a, 04103, Leipzig, Germany
| | - Andreas Merkenschlager
- University Hospital for Children and Adolescents, Centre of Pediatric Research, Liebigstraße 20a, 04103, Leipzig, Germany
| | - Wieland Kiess
- University Hospital for Children and Adolescents, Centre of Pediatric Research, Liebigstraße 20a, 04103, Leipzig, Germany
| | - Thilo Bertsche
- Drug Safety Center and Dept. of Clinical Pharmacy, Leipzig University, Brüderstraße 32, 04103, Leipzig, Germany
| | - Astrid Bertsche
- University Hospital for Children and Adolescents, Centre of Pediatric Research, Liebigstraße 20a, 04103, Leipzig, Germany. .,Neuropediatrics, University Hospital for Children and Adolescents, Ernst-Heydemann-Straße 8, 18057, Rostock, Germany.
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Bach VA, Neininger MP, Spindler UP, Hotopp LC, Hornemann F, Syrbe S, Merkenschlager A, Kiess W, Bernhard MK, Bertsche T, Bertsche A. How do parents perceive adverse drug events of their children's anticonvulsant medication? Eur J Paediatr Neurol 2018; 22:427-433. [PMID: 29475820 DOI: 10.1016/j.ejpn.2018.01.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 01/23/2018] [Accepted: 01/31/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND The main source of knowledge on adverse drug events (ADE) are physicians' reports in controlled clinical trials. In contrast, little is known about the parents' perception of ADE of anticonvulsants their children receive. METHODS After approval by the local ethics committee, we performed a survey in a neuropediatric outpatient clinic of a university hospital. Based on a structured questionnaire, we interviewed parents of children with current anticonvulsant treatment regarding (i) their fears about potential ADE, (ii) experienced ADE according to parents, and (iii) implications of ADE on the child's life. RESULTS Parents of 150 patients took part in the interview. (i) 95 (63.3%) parents expressed fears concerning ADE, mostly liver injury/liver failure (33 [22%]). (ii) 129 (86%) parents reported experienced ADE, mostly sedation (65 [43.3%]) and abnormal behavior (54 [36%]). (iii) Parents reported substantial implications of ADE on the child's daily life for 84 (56%) children, and 63 (42%) parents expressed a negative impact on the child's development. CONCLUSION We recognized a great discrepancy between those ADE that were feared and those that were experienced. Parents feared life-threatening ADE and experienced less severe ADE that nevertheless have a negative impact on the child's daily life.
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Affiliation(s)
- V A Bach
- University Hospital for Children and Adolescents, Center for Pediatric Research, Liebigstraße 20a, 04103 Leipzig, Germany
| | - M P Neininger
- Drug Safety Center and Department of Clinical Pharmacy, Leipzig University, Brüderstraße 32, 04103 Leipzig, Germany
| | - U P Spindler
- University Hospital for Children and Adolescents, Center for Pediatric Research, Liebigstraße 20a, 04103 Leipzig, Germany
| | - L C Hotopp
- University Hospital for Children and Adolescents, Center for Pediatric Research, Liebigstraße 20a, 04103 Leipzig, Germany
| | - F Hornemann
- University Hospital for Children and Adolescents, Center for Pediatric Research, Liebigstraße 20a, 04103 Leipzig, Germany
| | - S Syrbe
- University Hospital for Children and Adolescents, Center for Pediatric Research, Liebigstraße 20a, 04103 Leipzig, Germany; Department of General Paediatrics, Division of Child Neurology and Inherited Metabolic Diseases, Centre for Paediatrics and Adolescent Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany
| | - A Merkenschlager
- University Hospital for Children and Adolescents, Center for Pediatric Research, Liebigstraße 20a, 04103 Leipzig, Germany
| | - W Kiess
- University Hospital for Children and Adolescents, Center for Pediatric Research, Liebigstraße 20a, 04103 Leipzig, Germany
| | - M K Bernhard
- University Hospital for Children and Adolescents, Center for Pediatric Research, Liebigstraße 20a, 04103 Leipzig, Germany
| | - T Bertsche
- Drug Safety Center and Department of Clinical Pharmacy, Leipzig University, Brüderstraße 32, 04103 Leipzig, Germany
| | - A Bertsche
- University Hospital for Children and Adolescents, Center for Pediatric Research, Liebigstraße 20a, 04103 Leipzig, Germany; University Hospital for Children and Adolescents, Neuropediatrics, Ernst-Heydemann-Straße 8, 18057 Rostock, Germany.
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Beliveau PJH, Wong JJ, Sutton DA, Simon NB, Bussières AE, Mior SA, French SD. The chiropractic profession: a scoping review of utilization rates, reasons for seeking care, patient profiles, and care provided. Chiropr Man Therap 2017; 25:35. [PMID: 29201346 PMCID: PMC5698931 DOI: 10.1186/s12998-017-0165-8] [Citation(s) in RCA: 147] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 10/31/2017] [Indexed: 12/31/2022] Open
Abstract
Background Previous research has investigated utilization rates, who sees chiropractors, for what reasons, and the type of care that chiropractors provide. However, these studies have not been comprehensively synthesized. We aimed to give a global overview by summarizing the current literature on the utilization of chiropractic services, reasons for seeking care, patient profiles, and assessment and treatment provided. Methods Systematic searches were conducted in MEDLINE, CINAHL, and Index to Chiropractic Literature using keywords and subject headings (MeSH or ChiroSH terms) from database inception to January 2016. Eligible studies: 1) were published in English or French; 2) were case series, descriptive, cross-sectional, or cohort studies; 3) described patients receiving chiropractic services; and 4) reported on the following theme(s): utilization rates of chiropractic services; reasons for attending chiropractic care; profiles of chiropractic patients; or, types of chiropractic services provided. Paired reviewers independently screened all citations and data were extracted from eligible studies. We provided descriptive numerical analysis, e.g. identifying the median rate and interquartile range (e.g., chiropractic utilization rate) stratified by study population or condition. Results The literature search retrieved 14,149 articles; 328 studies (reported in 337 articles) were relevant and reported on chiropractic utilization (245 studies), reason for attending chiropractic care (85 studies), patient demographics (130 studies), and assessment and treatment provided (34 studies). Globally, the median 12-month utilization of chiropractic services was 9.1% (interquartile range (IQR): 6.7%-13.1%) and remained stable between 1980 and 2015. Most patients consulting chiropractors were female (57.0%, IQR: 53.2%-60.0%) with a median age of 43.4 years (IQR: 39.6-48.0), and were employed (median: 77.3%, IQR: 70.3%-85.0%). The most common reported reasons for people attending chiropractic care were (median) low back pain (49.7%, IQR: 43.0%-60.2%), neck pain (22.5%, IQR: 16.3%-24.5%), and extremity problems (10.0%, IQR: 4.3%-22.0%). The most common treatment provided by chiropractors included (median) spinal manipulation (79.3%, IQR: 55.4%-91.3%), soft-tissue therapy (35.1%, IQR: 16.5%-52.0%), and formal patient education (31.3%, IQR: 22.6%-65.0%). Conclusions This comprehensive overview on the world-wide state of the chiropractic profession documented trends in the literature over the last four decades. The findings support the diverse nature of chiropractic practice, although common trends emerged.
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Affiliation(s)
| | - Jessica J. Wong
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, Canada
- Department of Research, Canadian Memorial Chiropractic College, 6100 Leslie St, Toronto, ON M2H 3J1 Canada
| | - Deborah A. Sutton
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, Canada
| | - Nir Ben Simon
- Department of Research, Canadian Memorial Chiropractic College, 6100 Leslie St, Toronto, ON M2H 3J1 Canada
| | - André E. Bussières
- School of Physical and Occupational Therapy, McGill University, Montréal, Canada
- Département chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
- Centre de recherche interdisciplinaire en réadaptation (CRIR), Montréal, Canada
| | - Silvano A. Mior
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, Canada
- Department of Research, Canadian Memorial Chiropractic College, 6100 Leslie St, Toronto, ON M2H 3J1 Canada
| | - Simon D. French
- Department of Public Health Sciences, Queen’s University, Kingston, Canada
- School of Rehabilitation Therapy, Queen’s University, Kingston, Canada
- Department of Chiropractic, Macquarie University, Sydney, Australia
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Sobo EJ. Parent use of cannabis for intractable pediatric epilepsy: Everyday empiricism and the boundaries of scientific medicine. Soc Sci Med 2017; 190:190-198. [PMID: 28865255 DOI: 10.1016/j.socscimed.2017.08.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 08/01/2017] [Accepted: 08/04/2017] [Indexed: 12/20/2022]
Abstract
Cannabis is an increasingly sought-after remedy for US children with intractable (biomedically uncontrollable) epilepsy. However, like other complementary-alternative medicine (CAM) modalities, and particularly as a federally illegal, stigmatized substance, it is unsanctioned by mainstream medicine. Parents are largely on their own when it comes to learning about, procuring, dispensing, and monitoring treatments. Exploring how they manage is crucial to better assist them. Moreover, it can illuminate how 'research' done on the ground by laypeople variously disrupts and reinforces lay-expert and science-non-science divides. To those ends, in 2016, 25 Southern California parents who used, had used, or sought to use cannabis pediatrically for epilepsy/seizures were interviewed regarding their evidentiary standards, research methods, and aims when trying the drug. Parents generally described their work as experimentation; they saw their efforts as adhering to authorized scientific practices and standards, and as contributing to the authorized medical cannabis knowledge base. Findings subverted assumptions, based on an outdated stereotype of CAM, that cannabis-using parents do not believe in biomedicine. Indeed, parents' desire for their children's biomedical demarginalization, combined with biomedical dependency and a high caregiver burden, fueled a collaborative stance. Implications for understanding the boundaries of science are explored, as are norms for parent agency as ill children's care managers, radicalization among people affected by contested illnesses, and the future of 'medical marijuana.'
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Ustuner Top F, Konuk Sener D, Cangur S. Parental attitudes toward pediatric use of complementary/alternative medicine in Turkey. J SPEC PEDIATR NURS 2017. [PMID: 28639424 DOI: 10.1111/jspn.12186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE This study was conducted to determine the pediatric usage of complementary/alternative medicine (CAM) by parents in Turkey, the incidence of using these methods, and the factors affecting their use. DESIGN AND METHODS The sectional and relational design of the study included a sample of 497 parents who took children for treatment at the Maternity and Children's Hospital in Giresun, Turkey. Data for the study were collected via the Personal Information Form and the Evaluation Form for Complementary/Alternative Treatment Use. The data collection tools were filled out by the researchers during the face-to-face interviews. Data obtained from the study were analyzed by Pearson chi-square, Fisher-Freeman-Halton and Fisher's exact (posthoc Bonferroni) tests and Z-test. RESULTS It was determined that 97.7% of the parents had used at least one CAM method. Moreover, the parents had used CAM methods mostly for respiratory complaints. The CAM methods were most commonly used for the symptoms of fever, diarrhea, and cough. It was observed that the most commonly used alternative methods in the past were vitamin/mineral remedies, cold treatments, and hodja (Islamic teacher) consultations, while the most common alternative methods currently used are massage, music, and cold treatment. In addition, the differences found between CAM users in terms of sociodemographic characteristics were not statistically significant. PRACTICE IMPLICATIONS It is crucial for nurses to learn the characteristics of the health/disease treatments used by those with whom they work in order to increase the efficiency of the service they provide. Thus, it was recommended that nurses should be knowledgeable and aware of the benefits/side effects, treatment methods, and contraindications of CAM.
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Affiliation(s)
- Fadime Ustuner Top
- Department of Nursing, School of Health Sciences, Giresun University, Giresun, Turkey
| | - Dilek Konuk Sener
- Department of Nursing, School of Health Sciences, Duzce University, Duzce, Turkey
| | - Sengul Cangur
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Duzce University, Duzce, Turkey
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Beattie JF, Thompson MD, Parks PH, Jacobs RQ, Goyal M. Caregiver-reported religious beliefs and complementary and alternative medicine use among children admitted to an epilepsy monitoring unit. Epilepsy Behav 2017; 69:139-146. [PMID: 28285234 DOI: 10.1016/j.yebeh.2017.01.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 01/26/2017] [Accepted: 01/26/2017] [Indexed: 10/20/2022]
Abstract
Complementary and alternative medicine (CAM) includes a wide range of practices and products that are generally outside the use of conventional medicine as practiced in Western cultures. Use of CAM in persons with epilepsy is high, even compared to individuals with other chronic health conditions. In this study, we surveyed caregivers of children admitted to a regional epilepsy monitoring unit (EMU) in the southeast United States to assess CAM use among patients (N=225). Thirteen percent of respondents indicated current use of CAM by their child, 16% reported past use, and 43% reported interest in future use, most commonly in marijuana as a potential treatment (23%). Over 25% of respondents expressed interest in CAM use related to side effects of anti-epileptic medications. Regarding prayer as a form of CAM, a large majority of respondents in this sample identified as Christian and actively prayed for their child's illness, revealing a high prevalence of spiritual practices in this population. Eighty-one percent of respondents reported that they had not discussed CAM use with their doctor. Discussing CAM use with a health care provider was significantly related to past CAM use (p<.02), but not current use or willingness to try CAM in the future (p>.05). These results have important implications for future practice and support increased communication and patient education, as many anti-epileptic medications interact with certain herbs and supplements, posing a potential health risk and treatment barrier in this population.
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Affiliation(s)
- Julia Fleming Beattie
- Department of Psychology, University of Alabama at Birmingham, Campbell Hall 415, 1720 2nd Avenue South, Birmingham, AL 35294, USA.
| | - Matthew D Thompson
- Children's of Alabama, 1600 7th Avenue South, Birmingham, AL 35233, USA.
| | - Pamela H Parks
- Children's of Alabama, 1600 7th Avenue South, Birmingham, AL 35233, USA.
| | - Ruth Q Jacobs
- Department of Psychology, University of Alabama at Birmingham, Campbell Hall 415, 1720 2nd Avenue South, Birmingham, AL 35294, USA.
| | - Monisha Goyal
- Department of Pediatrics, Division of Neurology, University of Alabama at Birmingham, 1600 7th Ave S, Birmingham, AL 35233, USA.
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